MEDICARE: JOSEPH V BARRESI ODPA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	410046313	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2022593	OTHER	ME	AETNA
3	8047994	OTHER	ME	CIGNA
4	A08007219	OTHER		DMERC SUBMITTER NUMBER
5	024174	OTHER	ME	ANTHEM

General Provider Information

NPI Number	:	1164555603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSEPH V BARRESI ODPA

Provider Business Mailing Address
First Line	:	12 W MAIN ST
Second Line	:
City	:	FORT KENT
State	:	ME
Zip	:	04743-1231
Country	:	US
Telephone Number	:	207-834-3124
Fax Number	:	207-834-3127

Provider Business Practice Location Address
First Line	:	12 W MAIN ST
Second Line	:
City	:	FORT KENT
State	:	ME
Zip	:	04743-1231
Country	:	US
Telephone Number	:	207-834-3124
Fax Number	:	207-834-3127

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID A MITCHELL
Credential	:	OD
Telephone Number	:	207-834-3124

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	12/22/2008

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